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Some studies observed differences in motor control of the spine between women with pregnancy-related lumbopelvic pain and matched controls. Understanding alterations in spine motor control may help optimizing treatment in this population. The objective is to determine if there are differences in motor control of the spine in pregnant and post-partum women with and without pregnancy-related lumbopelvic pain. Five databases were searched: MEDLINE, Embase, CINAHL, Web of Science and Evidence-Based Medicine Reviews (last search: February 4th 2021). Observational studies that compared motor control of the lumbopelvic spine (in terms of muscle activation [e.g. using EMG or ultrasound imaging] or kinematics) between women with pregnancy-related lumbopelvic pain and matched controls were included. Risk of bias was assessed with a modified version of STROBE statement for cross-sectional studies. No meta-analysis was performed. Fifteen studies were included. Compared to matched controls, pregnant women with pregnancy-related lumbopelvic pain showed differences in lumbar spine kinematic during walking and lifting, although not consistent between studies. The only consistent results were higher transversus abdominis muscle activation during leg movements in post-partum pregnancy-related lumbopelvic pain. Differences in pelvic floor muscle function was inconsistent. This systematic review identified multiple differences in motor control in pregnancy-related lumbopelvic pain population, predominantly in dynamic tasks. However, consistent differences in lumbopelvic spine motor control were rare. More studies are necessary to determine if motor control is different in pregnancy-related lumbopelvic pain to better understand alteration in motor control and to optimize the efficacy of rehabilitation treatments. • Women with and without pregnancy-related lombopelvic pain were compared. • Kinematics differences during walking were present but differ between studies. • Transversus abdominis activation during leg movement was larger in lumbopelvic pain. • Differences in pelvic floor muscle function were inconsistent. • Stereotyped motor control alterations of the lumbopelvic spine were not observed. [ABSTRACT FROM AUTHOR]

Objective To study whether pregnancy-related lumbopelvic pain outcomes at 36 weeks of gestation can be predicted by psychological determinants earlier in pregnancy. Design Prospective cohort study. Setting Nine midwifery practices in different regions of the Netherlands. Population A cohort of 223 low-risk pregnant women in the Netherlands was followed from week 12 of gestation until 36 weeks of gestation. Methods Both psychological determinants and lumbopelvic pain symptoms were investigated with a set of questionnaires at 12, 24 and 36 weeks of gestation. Psychological determinants were measured with the Perceived Stress Scale ( PSS), the Symptom Checklist-90-Revised ( SCL-90), the Pregnancy-related Anxiety Questionnaire ( PRAQ), and the Utrecht Coping List ( UCL). Lumbopelvic pain outcomes were measured with the Pregnancy Mobility Index ( PMI) and the Overall Complaints Index ( OCI). Main outcome measures Lumbopelvic pain symptoms and their impact at 36 weeks of gestation. Results There was a significant increase in scores on both the PMI and OCI across the three sampling occasions in pregnancy. Lumbopelvic pain outcomes showed significant associations with the psychological determinants perceived stress and recently perceived psychological and physical distress at all three times during pregnancy. Pregnancy-related anxiety was not a significant predictor of lumbopelvic pain outcomes, neither was coping. Conclusions Lumbopelvic pain symptoms and their impact on daily activities at 36 weeks of gestation can be predicted by psychological determinants earlier in pregnancy; the combination of perceived stress and physical disability at 24 weeks of pregnancy seems to be the best predictor of disability in later pregnancy. [ABSTRACT FROM AUTHOR]

Objectives: In this study, we aimed to clarify the impact of a Pilates-based therapeutic exercise on disability, pain, mood, and sleep quality in patients with pregnancy-related lumbopelvic pain (LPP)., Patients and Methods: In the single-blinded randomized controlled study conducted between January 2018 and June 2018, 34 pregnant women (mean age: 29.7±6.2 years; range, 18 to 40 years) in the second trimester (week 14-24) with LPP were randomly assigned to a control group and a Pilates group. All patients underwent usual prenatal care. In addition, the selected Pilates exercise was carried out twice a week for 60-min per session for 12 weeks in the Pilates group. The control group was not prescribed an exercise regimen; however, they were not discouraged from exercising. The primary outcome was disability; secondary outcomes were LPP, mood, and sleep quality. Disability [Roland-Morris Disability Questionnaire (RMDQ)], LPP [Visual Analog Scale (VAS)], mood [Hospital Anxiety and Depression Scale, Anxiety (HADS-A) and Depression (HADS-D) subscales], and sleep quality [Pittsburgh Sleep Quality Index (PSQI)] were measured before and after 12 weeks. Adverse effects and adherence were recorded to determine exercise safety and compliance. The intention-to-treat analysis was applied., Results: The between-group effect sizes were moderate for the RMDQ and VAS scales (d=0.4 and d=0.7, respectively) and small for the HADS-A and HADS-D scales (both d=0.2). The intention-to-treat analysis demonstrated that there was a statistically significant difference in disability, pain, and mood in favor of the Pilates group (p0.05)., Conclusion: Adding Pilates to usual prenatal care should be considered a promising treatment option for pregnancy-related LPP., Competing Interests: Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article., (Copyright © 2023, Turkish Society of Physical Medicine and Rehabilitation.)

Abstract: There is a common belief that the laxity of pelvic joints increases in pregnancy. The hormone relaxin is suggested to be one of the most influential factors implementing this effect. Furthermore, increased laxity is assumed to induce pelvic girdle pain (PGP). The objectives were to examine the serum relaxin levels in pregnancy and to investigate whether relaxin levels relate to symptoms and clinical tests for PGP. Data from questionnaires, clinical tests and blood samples were collected once in pregnancy (gestation week 5–24) from 212 women. Serum from blood samples were analyzed by ELIZA to determine the concentration of relaxin. Self reported symptoms were assessed by Disability Rating Index (DRI) and pain intensity (VAS). Clinical examinations included Active Straight Leg Raise (ASLR) test and pain provocation tests. ANOVA was used to assess the effect of gestation age and multivariable statistics to examine the association between relaxin levels and the symptoms or responses to clinical tests. The serum levels of relaxin varied widely between individuals and were only marginally influenced by the gestation age. There was no association between gestation age and responses to clinical tests or pain intensity, but DRI increased with gestation age. Serum concentration of relaxin showed a significant association to positive score on the ASLR test, but no significant associations to responses to pain provocation tests, pain intensity or DRI. The results indicate that relaxin contributes to laxity of pelvic joints in pregnancy. Yet, no evidence of relaxin having an impact on symptoms or perceived disability was found. [Copyright &y& Elsevier]

Copyright of Romanian Journal of Physical Therapy / Revista Romana de Kinetoterapie is the property of University of Oradea Publishing House and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective. To study lumbopelvic pain in women randomized to a regular exercise program during pregnancy in comparison to women receiving standard antenatal care. Design. A two-armed, two-center, randomized controlled trial. Setting. St Olavs Hospital, Trondheim University Hospital and Stavanger University Hospital. Population. A total of 855 pregnant women were randomized to intervention or control groups. Methods. The intervention was a 12 week exercise program, including aerobic and strengthening exercises, conducted between 20 and 36 weeks of pregnancy. One weekly group session was led by physiotherapists, and home exercises were encouraged twice a week. The control group received standard antenatal care. Main outcome measures. Self-reports of lumbopelvic pain and sick leave due to lumbopelvic pain. The data were analysed according to the 'intention-to-treat' principle. Results. There were no significant differences between groups of women reporting lumbopelvic pain at 36 weeks (74 vs. 75%, p=0.76). The proportion of women on sick leave due to lumbopelvic pain was lower in the intervention group (22% vs 31%, p=0.01). Conclusions. Exercise during pregnancy does not influence the prevalence of lumbopelvic pain, but women offered a regular exercise course seem to handle the disorder better. [ABSTRACT FROM AUTHOR]

Aims and objectives. To examine the associations between pain-related psychological and social factors and pregnancy-related lumbopelvic pain intensity and interference after controlling biological factors. Background. Pregnancy-related lumbopelvic pain is prevalent and has been shown to interfere with women's quality of life. Although pain is a multidimensional phenomenon known to be influenced by psychosocial factors, the majority of previous research on this pregnancy-related lumbopelvic pain has focused on biological factors. Design. Cross-sectional correlational research. Method. A sample of 183 pregnant women with lumbopelvic pain was recruited from a medical center in northern Taiwan. Study participants provided demographic information and were administered the Brief Pain Inventory and a modified Catastrophising subscale of the Coping Strategies Questionnaire. Multiple regressions were used to examine the associations among the study variables. Results. Analyses indicated that lower education level was associated with higher pain intensity. Higher pain intensity during pregnancy and catastrophising cognitions were associated significantly with higher pain interference. Moreover, age moderated the strength of the association between pain intensity and pain interference. This association was stronger for older than for younger women. Conclusions. This study identified the psychosocial factors associated with pregnancy-related lumbopelvic pain intensity (educational level) and interference (pain intensity and catastrophising) and also a variable (age) that moderated the association between pain intensity and pain interference. The findings support a biopsychosocial approach in understanding the experience and impact of pregnancy-related lumbopelvic pain. Relevance to clinical practice. Nurses should assess pregnant clients' age, educational level, pain intensity and pain catastrophising thoughts to help identify women who are more at risk for higher lumbopelvic pain intensity or interference. Women endorsing catastrophising cognitions should be referred to or provided with treatment to reduce the frequency of these cognitions that are known to have a negative impact on quality of life in other pain populations. [ABSTRACT FROM AUTHOR]

Abstract: This study was undertaken to determine the effect of changing standing lumbopelvic posture on pelvic floor muscle (PFM) activation amplitude and timing and the resultant vaginal manometry values recorded during static and dynamic tasks. Sixteen nulliparous, continent women between the ages of 22 and 41years performed five tasks (quiet standing, maximal effort cough, Valsalva manoeuvre, maximum voluntary contraction (MVC) of the PFMs, and a load-catching task) in three different standing postures (normal lumbopelvic posture, hyperlordosis and hypolordosis). Electromyographic (EMG) data were recorded from the PFMs bilaterally using a Periform™ vaginal probe coupled to Delsys™ Bagnoli-8 EMG amplifiers. In separate trials, vaginal manometry was obtained using a Peritron™ perineometer. Lumbopelvic angle was recorded simultaneously with EMG and vaginal manometry using an Optotrak™ 3D motion analysis system to ensure that subjects maintained the required posture throughout the three trials of each task. All data were filtered using a moving 100ms RMS window and peak values were determined for each trial and task. Repeated-measures analyses of variance were performed on the peak PFM EMG, intra-vaginal pressure amplitudes, and lumbopelvic angles as well as activation onset data for the cough and load-catching tasks. There was significantly higher resting PFM activity in all postures in standing as compared to supine, and in the standing position, there was higher resting PFM activity in the hypo-lordotic posture as compared to the normal and hyperlordotic postures. During the MVC, cough, Valsalva, and load-catching tasks, subjects generated significantly more PFM EMG activity when in their habitual posture than when in hyper- or hypo-lordotic postures. Conversely, higher peak vaginal manometry values were generated in the hypo-lordotic posture for all tasks in all cases. These results clearly indicate that changes in lumbopelvic posture influence both the contractility of the PFMs and the amount of vaginal pressure generated during static postures and during dynamic tasks. Lumbopelvic posture does not, however, appear to have a significant effect on the timing of PFM activation during coughing or load-catching tasks. [Copyright &y& Elsevier]

Abstract: The objective of this prospective cohort study was to examine how results of clinical tests on women with pelvic girdle pain (PGP) in late pregnancy were associated with disability and pain intensity 12 weeks postpartum controlling for socio-demographical and psychological factors. Out of the 283 women clinically examined in gestation week 30, 179 were considered afflicted from PGP and constituted the study sample. Potential risk factors were assessed by questionnaires (at inclusion and in gestation week 30) and clinical examination in gestation week 30. The clinical examination included pain provocation tests for the pelvis as well as the active straight leg raise test. We used pain intensity and disability (disability rating index, DRI) as response variables, derived from questionnaires 12 weeks postpartum. Using multivariable linear regression analyses, sum of pain provocation tests and pre-pregnancy low back pain (LBP) were significantly associated with DRI 12 weeks postpartum. Furthermore, sum of pain provocation tests and number of pain sites were significantly associated with pain intensity. In conclusion, we found that when including results of clinical tests as risk factors together with socio-demographical and psychological factors in multivariable regression models, the clinical risk factors are the ones that remain significant. These results are of clinical importance because they seem to have the potential to identify women with a poor prognosis. [Copyright &y& Elsevier]

Abstract: The purpose of this study was to compare the change in thickness of transversus abdominis (TrA) and internal oblique (IO) muscles, during resting supine respiration, in individuals with lumbopelvic pain (LP) to those who in addition to LP, demonstrate signs of concurrent hypocapnia (LP&HYPO). B-mode ultrasound images were obtained at the height of inspiration, and at the end of expiration, over three subsequent breaths during a single session. The average percent change in thickness of TrA during resting respiration in the LP&HYPO group (20.8±7.6%) was found to be statistically greater (P<0.001) than that of the LP only group (1.3±5.8%), while the difference between the groups for the percent change in thickness of IO (LP&HYPO 9.2±8.1%, LP 2.0±7.2%) did not differ (P=0.073). These findings suggest that respiratory modulation of TrA thickness, as measured by ultrasound imaging, greater than 20%, detected in a resting supine position, may be associated with an episode of hypocapnia, and if present warrants further investigation. [Copyright &y& Elsevier]

Background. Prevention of lumbopelvic pain in pregnancy has been sparsely studied. One aim of this study was to assess if a 12-week training program during pregnancy can prevent and/or treat lumbopelvic pain. A randomized controlled trial was conducted at Trondheim University Hospital and three outpatient physiotherapy clinics. Three hundred and one healthy nulliparous women were included at 20 weeks of pregnancy and randomly allocated to a training group (148) or a control group (153). Methods. The outcome measures were self-reported symptoms of lumbopelvic pain (once per week or more), sick leave, and functional status. Pain drawing was used to document the painful area of the body. The intervention included daily pelvic floor muscle training at home, and weekly group training over 12 weeks including aerobic exercises, pelvic floor muscle and additional exercises, and information related to pregnancy. Results. At 36 weeks of gestation women in the training group were significantly less likely to report lumbopelvic pain: 65/148 (44%) versus 86/153 (56%) (p=0.03). Three months after delivery the difference was 39/148 (26%) in the training group versus 56/153 (37%) in the control group (p=0.06). There was no difference in sick leave during pregnancy, but women in the training group had significantly (p=0.01) higher scores on functional status. Conclusions. A 12-week specially designed training program during pregnancy was effective in preventing lumbopelvic pain in pregnancy. [ABSTRACT FROM AUTHOR]

Background: Active Straight Leg Raise (ASLR) is a clinical test that challenges lumbopelvic stability and have been used in low back pain patients. There are reports of positive tests in asymptomatic individuals, however, it is not clear if they are false positives or a consequence of performing the test differently., Objectives: To compare abdominal muscles activity and pelvic motion during an ASLR between adults with chronic low back pain and asymptomatic participants with a positive and negative ASLR test., Design: Cross-sectional study design., Method: Nineteen volunteers with chronic nonspecific low back pain (LBP) and 19 asymptomatic, 12 with a negative ASLR (AG-) and 7 with a positive ASLR test (AG+) were assessed while performing an ASLR (dynamic postural challenge). Pelvic rotation and medio-lateral center of pressure displacement (COPml), as well as bilateral EMG abdominal muscles activity were assessed. Muscles asymmetry index were also analyzed. Kruskal-wallis test was used to compare groups (α = 0.05)., Results: Both LBP and AG + displayed significantly less contralateral internal oblique/transversus abdominis (IO/TrA) muscle activation than AG- (p = 0.003 and p = 0.005, respectively) and also more asymmetry between sides in the IO/TrA than AG- (p = 0.022 and p = 0.004, respectively). No significant differences between LBP and AG+ were found (p > 0.05)., Conclusion: A positive ASLR test in an asymptomatic person could be more than a false positive, since IO/TrA muscle activation appears to be lower and more asymmetrical in people with a positive ASLR test, both with and without low back pain. Future studies may consider removing asymptomatic individuals with a positive ASLR., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Copyright of Chiropractic & Manual Therapies is the property of BioMed Central and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To investigate whether kinesiophobia with pregnancy-related lumbopelvic pain at late pregnancy influenced depressive symptoms at 1 month after delivery., Method: Final participants were 43 pregnant women who experienced pregnancy-related lumbopelvic pain at late pregnancy and completed self-reported questionnaires at late pregnancy and 1 month after delivery. The Tampa Scale for Kinesiophobia was used to evaluate kinesiophobia, and depressive symptoms were assessed using the Self-Rating Depression Scale. We divided participants into two groups (depression and no-depression) using the score of the Self-Rating Depression Scale at 1 month after delivery. Univariate analysis and multiple logistic regression analysis identified kinesiophobia at late pregnancy as an independent predictor of depression at 1 month after delivery., Results: In univariate analysis, kinesiophobia at late pregnancy was significantly higher in the depression group than in the no-depression group (P= .033). In multiple logistic regression analysis, kinesiophobia at late pregnancy were significantly associated with depression at 1 month after delivery even after adjusting for confounding factors (Odds Ratio, 1.25; 95% Confidence Interval, 1.03-1.52)., Conclusion: Results found that kinesiophobia at late pregnancy negatively influenced depressive symptoms at 1 month after delivery, suggesting that approaches to treat kinesiophobia at late pregnancymight reduce the risk of onset of postpartum depressive symptoms., Competing Interests: The authors have no conflict of interest directly relevant to the content of this article., (2020, JAPANESE PHYSICAL THERAPY ASSOCIATION.)

[Purpose] To determine if pressure biofeedback unit readings are related to abdominal muscle activation and centre of pressure displacement as well as to test the effects of using it as a biofeedback tool to control lumbopelvic motion. [Participants and Methods] Eighteen volunteers with chronic nonspecific low back pain (21.28 ± 1.41 years old) who performed an active straight leg raising (dynamic postural challenge) with and without pressure biofeedback. Changes in the pressure biofeedback unit and on centre of pressure displacement were assessed, as well as bilateral electromyographic abdominal muscle activity. Participants were not allowed to use a Valsalva manoeuvre. [Results] Pressure variation was not significantly correlated with abdominal muscle activity or with mediolateral centre of pressure displacement. When used as a biofeedback instrument, there was a significant increase in almost all abdominal muscles activity as well as a significant decrease in pressure variation and in mediolateral centre of pressure displacement while performing an active straight leg raising with a normal breathing pattern. [Conclusion] Despite not being an indicator of abdominal muscle activity or mediolateral load transfer in the supine position, the pressure biofeedback unit could have great relevance when used in the clinic for biofeedback purposes in individuals with low back pain., (2019©by the Society of Physical Therapy Science. Published by IPEC Inc.)

Background: The prevalence, cost and disability associated with lumbopelvic pain continues to rise despite the range of available therapeutic interventions, indicating a deficiency in current approaches. A literature base highlighting a correlation between lumbopelvic pain and pelvic floor function is developing; however, the features that characterize this correlation have yet to be fully established., Purpose: The purpose of this study was to determine the prevalence and characteristics of pelvic floor muscle function among women with lumbopelvic pain., Methods: A cross-sectional study was conducted on non-pregnant women presenting with lumbopelvic pain to one of seven outpatient orthopaedic clinics in Canada. Potential participants underwent a screening process to assess for pelvic floor muscle dysfunction., Results: A total of 182 women were recruited and 97 were excluded, leaving 85 participants (n = 85). Of these, 95.3% were determined to have some form of pelvic floor dysfunction. Specifically, 71% of the participants had pelvic floor muscle tenderness, 66% had pelvic floor weakness and 41% were found to have a pelvic organ prolapse. Participants with combined low back pain and pelvic girdle pain presented with higher levels of disability and increased characteristics of pelvic floor dysfunction., Conclusions: Our findings corroborate and extend recent research supporting the hypothesis that a high proportion of pelvic floor muscle dysfunction is present among women with lumbopelvic pain. Specifically, increased pelvic floor muscle pressure-pain sensitivity represented the most frequent characteristic, the clinical implications of which require further study., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background: Recent investigations have suggested that disrupted body-image may contribute to the lumbopelvic pain experience. The changes in body shape and size associated with pregnancy suggest that pregnancy-related lumbopelvic pain might be a problem in which alterations in body-image are particularly relevant., Objectives: To investigate if self-reported body-image is related to lumbopelvic pain status in women during pregnancy and explore the factors that might contribute to changes in body-image in women experiencing pregnancy-related lumbopelvic pain., Design: Cross-sectional cohort study., Method: Forty-two women in the third trimester of pregnancy were recruited regardless of clinical status. Pain intensity and disability were measured to estimate clinical severity. The Fremantle Back Awareness Questionnaire was used to assess body-image. Participants also completed a series of questionnaires and physical tests to explore factors that might be associated with altered body-image., Results: The median Fremantle Back Awareness Questionnaire score for the pain free women was 1 (IQR 0-1.5) and the median score for those in pain was 3.5 (IQR 2-8). This difference was statistically significant (p = 0.005). The questionnaire score was significantly correlated with pain intensity but not with disability. Of the measured variables only pain catastrophisation was significantly associated with disrupted body-image., Conclusions: Self-reported disruption of body-image was significantly greater in pregnant women who were experiencing lumbopelvic pain than those who weren't and the extent of body-image disruption was associated with pain intensity. Only pain related catastrophisation was related to disrupted body-image., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Since there is lack of up to date consensus exists as to whether group training is effective in improving lumbopelvic pain (LPP) after pregnancy, a review of the recent evidences is needed. To determine the effect of group exercise training for the management of LPP among pregnant women compared with usual antenatal care. An electronic database search for relevant randomized control trials published in English from 2006 to 2015 was conducted. Articles with outcome measures of self-reported LPP, visual analogue scale and sick leave due to LPP after pregnancy were included. Quality of the included articles was rated using Physiotherapy Evidence Database (PEDro) scale and the pooled effect of self-reported LPP was obtained by Review Manager (RevMan 5) software. Significant effect of group training was detected over usual antenatal care or no treatment with P=0.0035 (95% confidence interval, -0.2348 to -0.0044). The results of this systematic review proposed that group training reduces LPP significantly better than routine antenatal care for pregnant women suffered from LPP.

Pregnancy has a profound effect on the human body, particularly the musculoskeletal system. Hormonal changes cause ligamentous joint laxity, weight gain, and a shift in the center of gravity that leads to lumbar spine hyperlordosis and anterior tilting of the pelvis. In addition, vascular changes may lead to compromised metabolic supply in the low back. The most common musculoskeletal complaints in pregnancy are low back pain and/or pelvic girdle pain. They can be diagnosed and differentiated from each other by history taking, clinical examination, provocative test maneuvers, and imaging. Management ranges from conservative and pharmacologic measures to surgical treatment. Depending on the situation, and given the unique challenges pregnancy places on the human body and the special consideration that must be given to the fetus, an orthopaedic surgeon and the obstetrician may have to develop a plan of care together regarding labor and delivery or when surgical interventions are indicated., (Copyright 2015 by the American Academy of Orthopaedic Surgeons.)

Muscle energy technique (MET) is a form of manual therapy frequently used to correct lumbopelvic pain (LPP), herein the patient voluntarily contracts specific muscles against the resistance of the clinician. Studies on MET regarding magnitude and duration of effectiveness are limited. This study was a randomized controlled trial in which 20 subjects with self-reported LPP were randomized into two groups (MET or control) after magnitude of pain was determined. MET of the hamstrings and iliopsoas consisted of four 5-second hold/relax periods, while the control group received a sham treatment. Tests for current and worst pain, and pain with provocation were administered at baseline, immediately following intervention and 24 hours after intervention. Separate 2x3 ANOVAs were used to assess results as change scores. Visual analog score (VAS) for worst pain reported in the past 24 hours decreased for the MET group (4.3mm+/-19.9, p=.03) and increased for the sham (control) group (17.1mm+/-21.2, p=.03). Subjects receiving MET demonstrated a decrease in VAS worst pain over the past 24 hours, thereby suggesting that MET may be useful to decrease LPP over 24 hours.